PubMed · 14001813
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R R WOODS. 1963. Stapedectomy.. https://doi.org/10.1007/bf02969125
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OBJECTIVE: The purpose of this study was to assess the value of virtual endoscopy (VE) in the diagnosis of lesions of the ossicular chain and to compare virtual endoscopy and two-dimensional (2D) spiral computed tomography (CT) data. STUDY DESIGN: Retrospective study. SETTING: A university hospital. PATIENTS: Fifty-eight patients with suspected ossicular chain lesions underwent a high-resolution CT of the temporal bone with both 2D data and VE before surgery. MAIN OUTCOME MEASURES: Two views were chosen for VE. The CT data obtained (2D, VE, and both 2D and VE) were compared with the lesions noted during surgery. RESULTS: In the diagnosis of dislocation of the ossicles or prostheses, VE seemed to be a better technique than 2D CT. Views chosen for the VE proved to be ineffective for diagnosing epitympanic fixations. VE was not adapted to the study of otosclerosis. We found it necessary to use the data provided by the addition to 2D CT data in the diagnosis of ossicular lysis and minor aplasia. Radiologic analysis of the lesions of the long process of the incus and the incudostapedial joint was improved by performing both 2D CT and VE. VE reconstruction of the stapes proved to be difficult, especially in cases of inflammation of the middle ear. CONCLUSION: This study demonstrates the value of VE in the diagnosis of dislocation of the ossicles and ossicular prostheses. VE was less effective in diagnosing other pathologies of the ossicular chain.
BACKGROUND: During the last few years, several laser systems have been applied for procedures in middle ear surgery. In this study, we determined the technical parameters for the dissection of the middle ear ossicles with the CO(2) laser and analyzed the histological findings. METHODS: The malleus necks of 16 human temporal bones were dissected under standardized conditions using a CO(2) laser with a power output between 35 and 55 kW/cm(2). The specimens were fixed and histological probes of 50- micro m thickness were prepared. RESULTS: The laser outputs led to crater diameters from 0.14 to 0.55 mm. As an analogy between laser energy and thermal tissue destruction, three zones of thermal damage were differentiated: a cinder zone, a carbonization zone, and a zone of dehydration. The metrical dimensions of these zones did not show any correlation to the applied laser energy. CONCLUSIONS: The data of this study show that commercially available CO(2) lasers are sufficient for a safe and effective partial resection of middle ear ossicles using a power output of 35 kW/cm(2).
We have studied the development of the tympanic ossicles in 40 embryo-foetal human series aged between 32 days (6 mm) and newborn. Once performed the measurements to date chronologically embryos and foetuses, we did a meticulous dissection of temporal bones. After fix in 10% formol, decalcified with 2% nitric acid, embedded in Paraplast, sectioned in a sequence of 7 mm, and stained with Martin's trichrome. The tympanic ossicles are developed in the mesenchyme of the two first pharyngeal archs. The head of the malleus, the body and the short limb of the incus arise from the first arch while the handle of the malleus, the long limb of the incus and the mass of the stapes arise from the second arch. The vestibular side of the stapedial footplate develops in the otic capsule. The tympanic ossicles develop from endochondral ossification, while anterior process of the malleus has the membranous ossification. In their ontogenia 6 stages are observed. First stage, the formation of their sketch by mesenchimal condensation, in the second stage, "pre-cartilaginous", the cells of the primordia are differentiated into condroblasts, in the third stage "cartilaginous" the ossicles show a cartilaginous structure, in the forth stage the primary ossification centers are developed, in the fifth stage the ossicles arise in the periostic annulus and inside the endochondral bone, and in the last stage the osseous tissue grows until it acquires a compact osseous structure.